Transcript HEALTHCARE

HEALTHCARE
A BALANCE BETWEEN STATE &
LOCAL JURISDICTION, PUBLIC &
PRIVATE SECTOR
Ass.of private hc employers
Zagreb, Croatia
Ante Gabrilo B.Sc.E.
Croatian healthcare y 2007.
(facts & figures)(1)
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Population 2007.:
4,357 Mio
Active workers paying benefits:1,547 Mio
State fund income
2,475 Bln €
Budget transfers
165 Mio €
State fund expenses
2,539 Bln €
Debt (paid)
101 Mio €
Croatian healthcare - hc expenditures(2)
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Primary healthcare
401 Mio €
Secondary hc - hospitals
1,008 Bln €
Secondary hc - polyclinics
83 Mio €
Medications
481 Mio €
Sickness leave
175 Mio €
Maternity leave
94 Mio €
Others
297 Mio €
TOTAL expenses
2,539 Bln €
Debts(medications & hospitals)542 Mio €
Healthcare funding (y 2006)
Macro level imbalance between
High % of State fund/Low % of State budget
High % patients out of pocket/Low % private
hc insurances
100
Private
exp
Budget
State
fund
7
1 4
23
18
16
Out
pocket
2527
18 17
3
Public
exp
0
46
Private
insur
80 837573 80
60
55
% of total hc
40
29
20
Croatia
EU 15
EU 10
Healthcare expenses (y 2006)
Low% of primary hc/High% of hospitals,
Sickness & Maternity leave
1200
1008
953
800
600
400
y 2006
y 2007
481
424
401
381
200
175
158
7483
297
239
9294
M
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O
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Pr
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mio €
1000
Problems
• Primary healthcare funding dropped from 35% in 90*s
to 16% of total hc budget in 2007
• Capitation system in primary hc (fixed income for
every patient) encourages MDs to send patients to
secondary hc, not to cure themselves (as the result only
50% of diagnosis cured in primary hc/EU-15 75%)
• There are no funds for new equipment in primary hc,
just for secondary hc provided by the state
• Healthcare costs account for only 2,3% of average
household expenses
• Benefits for hc paid by employers among the highest in
Problems (2)
• Maternity ,sickness and invalidity account for 14% of
total hc expenses
• No participation in hc funding from municipalities
• Doctors & nurses in secondary level paid by their
education and status, not by achievement ( as the result 1
doctor in a hospital was absent 281 days/year attending
various seminars, congresses etc.paid by pharmaceutical
companies as stated in Evening post)
• Only 50% of diagnostic ˛laboratory analysis are referred
to family doctor
Solutions
• Increase state budget transfers for hc to 1520% as in the EU-10
• Increase private insurance funding to min.
5% of total hc funds
• Change from capitation system in primary
hc to services for price system
• Include depreciation of assets, resources for
new equipment etc. in the calculation of
price
Solutions (2)
• To increase participation from local municipalities in hc
funding
• Change of sallaries in secondary level from fixed to
variable method according to individual achievement
• Increase primary hc funding to 25-30% of total hc
funding in order to be able to cure up to 75% of all
diagnosis as in EU-15
• Division of work between general hospitals and clinical
hospitals
• Participation of patients for better control of hc
expenses
Solutions (3)
• Regionalization of hospitals with 1 hospital in the 50 km
radius (today we have 3 hospitals within 30 km range Vinkovci,Vukovar,Osijek with the total of 1760 beds this is a higher standard that should be covered by the
municipality if they can afford to)
• Standardization of hospitals according to the number of
beds, should have 300 to 500 beds to be cost effective
(today Clinical hospital Zagreb has 1673 beds,Hospital
Pakrac 115, Gospić 94, Đakovo 19 beds etc.)
• Hospitals as profit centers,as the 1.st step towards
privatization or private public partnership
Primary healthcare
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Private family practices:1297 MD´s
Private specialist practices:1280 Med. Specialists
Private dentist practices:1952 (1/1986 persons)
Average family practice has 1700 insured persons and
receives cca 48.200 €/year from State fund, family
specialist an extra 1850 €/year
• Patient check ups in 2006. 18,279 Mio; referrals to
specialist 7,408 Mio (28% of total visits)
Secondary outpatient healthcare
• Polyclinics 314, Pharmacy instituitions 177,
Nursing care instituitions 153, Health companies
46 (y 2006)
• Medical examinations total in instituitions who
have contract with the State fund 7.693.150
• Owned by private persons/companies or by
municipalities who are obligated to invest in their
equipment, resources etc., but they lack to do so
Secondary inpatient healthcare
• Number of hospital beds 24.237 (5,46 beds/1000
persons)
• Number of doctors 4.788 ( 1/5,1 beds)
• Nr.of patients discharged 752.453
• Average length of treatment 9,94 days
• Bed utilization 84,55%
• Hospital hc expenses are 1,008 Bln € or 40% of total hc
expenses
• Owned by municipalities and state (only 2 private
hospitals)
Municipalities
• Should invest in the equipment of instituitions
they own, organize primary hc themselves with
the resources available
• Should form a group of counties so they have 1
hospital in the 50 km range instead of several
• Should pay for higher standard of hc service if
they want a doctor in very low inhabited areas
• Should plan more resources for healthcare in their
budgets (City of Zagreb planned for their hc
instituitions in 2007. 14,45 Mio € and for sports
clubs 30 Mio €)
Conclusion
• Primary hc which is privately owned is by far most cost
effective level of hc with 16% of total hc expenses,
while secondary hc with 40% created additional cca 390
mio € of debts
• Neither state budget, nor municipalities budgets
participate enough in hc funding (state 3%,
municipalities less than 1% of total hc funding)
• Municipalities have many obligations to organize hc in
their region, but they lack to do so for reasons like
shortage of funds or other activities priority